Abstract Objective: To report recent changes in the epidemiology of Clostridium difficile–associated diarrhea (CDAD) and to discuss its diagnosis, treatment, and prevention. Methods: Qualitative review of the literature. Results: CDAD continues to be a major problem in the health care setting. A new virulent strain of C. difficile has been associated with several notable hospital outbreaks. This strain, called BI/NAP1, produces 16 to 23 times the amount of toxin A and B produced by standard strains and has been associated with more severe CDAD and increased mortality. In addition to previously identified predisposing factors, risk factors for CDAD associated with this new strain include age > 65 years and fluoroquinolone use. For initial treatment of mild to moderate CDAD, metronidazole is still recommended; however, vancomycin is now recommended as initial therapy in moderate to severe disease. Studies of new drugs for treatment of CDAD are currently in process. Recurrent diarrhea remains a frequent complication of CDAD, but studies are necessary to define the best approach for treatment of recurrent disease. Conclusion: A new strain of C. difficile has emerged that causes more severe disease and treatment failures with standard therapies. New, more effective treatment options are urgently needed.

Clinical Review Article

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